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Dodd not Odd in Prostate Cancer Advocacy

Senator Christopher Dodd (D-Connecticut) appears to be a newly-minted prostate cancer advocate. Two weeks ago he announced he had early-stage prostate cancer and would soon have robotic surgery. After I called one of his senate aides, I surmised that Sen. Dodd's prostatectomy will take place this week. As someone who was in his shoes just over two years ago (medically, only!), I empathize with him and like most of us, wish him well.

Sen. Dodd is a leader of the Senate committee considering the Obama-Biden health reform bill. I found it encouraging that as a leading health reform advocate he indicated before the August congressional break that he hopes all Americans will soon receive the same level of care he currently gets from his congressional health insurance group care program. As one of the best health programs in the world, the congressional plan includes coverage of routine annual screening for prostate and other forms of cancer.

I can't help but wonder, though, even if the health plan passes, if we'll eventually find that routine screening for prostate and other cancers WON'T be guaranteed. As new ways are sought to cut back on the catastrophically increasing federal budget, it may be that routine screening will eventually be seen as ill-advised and therefore become quite dispensable.

I base this on opposition from respected scientists and doctors like Dr. Otis Brawley, -an eminent oncologist who
is the chief medical officer of the American Cancer Society, and such
thought leaders as Dr. Deepak Chopra.

These and a growing number of experts might decide to testify to Congress that most routine cancer screenings prevent relatively few deaths, but lead to expensive treatment, often accompanied by adverse treatment effects like ED or incontinence. Their view, based on medical statistics, could easily lead to an attempt to deny payment for PSA tests and biopsies, unless symptoms are already present. Politicos may jump on this in an effort to cut treatment expenses in the billions of dollars.

Those who oppose routine screening correctly note that that a minority of men with prostate cancer (currently 27,000 annually), will die from it. And it's true that many more aggressive cases occurred suddenly when screening would not have prevented such a development. They are also correct in noting that excessive testing and finding early-stage prostate cancer over 80% of the time, can make many men and their wives or other companions all too anxious that the cancer will lead to death. There's room for anxiety, but we need to know that the vast majority of tumors are slow-growing and are not fatal.

But think about it: Even a rare case of death due to prostate cancer could involve a beloved family member. More importantly if prostate cancer screening is disallowed, how can we make sure to eliminate an early-stage cancer before it gets more aggressive? And that's what we probably will have to keep doing even though enlightened minds might regard this as overreaction. After all, scientists simply have not developed the tools to figure out if a less dangerous tumor might suddenly become aggressive, so taking action now might be the most prudent thing to do.

Right now nobody I know has connected the dots between increasing opposition to routine annual testing and the new health care policy all Americans will probably have to live with. Let's hope that the need for cost-cutting, along with well-meaning efforts to avoid excessive anxiety after too much testing, will not lead to revoking part of the newly liberalized healthcare policy.

The last thing we need now is for government to ban third-party payments for routine screening for prostate and many other cancers. Things are bad enough as is, without one more devastating policy change.